Project TEACHMotivational Interviewing (MI)

in Tobacco Cessation: An Overview—Part 8

Change Talk/Sustain TalkBased upon the work of William Miller, Ph.D. & Stephen

Rollnick, Ph.D.

Mark Evans, MSW, LCSW, CTTSMember, Motivational Interviewing Network of Trainers (MINT)

Change Talk & Sustain Talk

Change Talk and Sustain Talk

Opposite Sides of the Coin

RESISTANCE

Now known as

SUSTAIN TALK  DISCORD 

Sustain Talk & Discord Sustain Talk is about the target behavior:I really don’t want to quit smoking.I have to have my pills to make it through the day.

Discord is about your relationship:You can’t make me quit.You don’t understand how difficult it is for me.

Both are highly responsive to counselor style.  The Spirit of MI helps diffuse discord. 

Miller, WR and Rollnick, S.  Motivational Interviewing.  Helping People Change.   New York:  The Guilford Press.  2013.  Third Edition.

The other side of ambivalence/change talk Speech that favors arguments against change Desire for things to stay the same (status quo) Ability to continue with things just as they are Reasons NOT to change Need for things not to change Commitment to things just as they are

Sustain Talk

Miller, WR and Rollnick, S.  Motivational Interviewing.  Helping People Change.   New York:  The Guilford Press.  2013.  Third Edition.

Avoid arguing for change

Not directly opposed

A signal to respond differently

Sustain Talk

Miller, WR and Rollnick, S.  Motivational Interviewing.  Helping People Change.   New York:  The Guilford Press.  2013.  Third Edition.

“I really don’t want to stop smoking, but I know that I should.  I’ve tried before, and it’s really difficult.”

‐‐You really don’t want to quit.‐‐It’s pretty clear to you that you ought to quit.‐‐You don’t think you can quit.

Snatching Change Talk from the Jaws of Ambivalence

Speech that favors movement in the direction of change…. Opposite of “Sustain Talk”  Specific to a particular target behavior 

or set of target behaviors (e.g., smoking, diet, exercise)

What sorts of things  do you say when you are considering a change?  What do we watch for…?

Change Talk

Miller, WR and Rollnick, S.  Motivational Interviewing.  Helping People Change.   New York:  The Guilford Press.  2013.  Third Edition.

Change TalkDARN-CATs

Preparatory Change Talk—DARN (usually comes before Activating

Change Talk) DESIRE to change (want, like, wish…) ABILITY to change (can, would…) REASONS to change (if…then) NEED to change (need, have to, must, got       to…)

Miller, WR and Rollnick, S.  Motivational Interviewing.  Helping People Change.   New York:  The Guilford Press.  2013.  Third Edition.

Example - In the Courtroom/At the Wedding

“Do you swear to tell the whole truth…?” Desire Ability Reason Need

Activating Change Talk COMMITMENT Language (intention, decision) ACTIVATION (ready, prepared, willing) TAKING steps

You now have the DARN‐CATMiller, WR and Rollnick, S.  Motivational Interviewing.  Helping People Change.   New York:  The Guilford Press.  2013.  Third Edition.

Questions to Possibly Elicit/Evoke COMMITMENT Language

Is that what you want to do? Can you do it? Do you have enough reasons to do this? How important is it to do this for you? Will you do it?

(YIKES—CLOSED‐ENDED QUESTIONS—can you make them OPEN‐ENDED...or turn in them into reflections?) And sometimes a closed‐ended question is needed/ok. Even more so as of Oct. 2014! 

What do you want to do? Do you think you can do it? What steps are you willing to take? What are the best reasons for making a change? How important is this change to you? How will you do this?  

Which question would you ask to elicit/evoke ACTIVATION

language?

Mark Evans LCSW Training Nov 2014

Example - In the Courtroom/At the Wedding Revisited

“Do you swear to tell the whole truth…?” “Do you take this man/woman…?” COMMITMENT:  “I DO!”  “I WILL!”

Find the Activating or Commitment Language

I’ve got to start exercising. I wish I could eat better.  I’m not buying anymore junk food. I think I can eat better. I’d be a lot more healthy if I ate better.  I know I can lose weight. 

Find the Activating or Commitment Language

(continued)

I’ve got to quit smoking. I wish I could quit. I’m not buying another pack. I’d be healthier if I quit. I think I can quit.

Find the Activating or Commitment Language

(continued)

I’ve got to start exercising. Dr. S.  won’t do reconstructive surgery if I’m not nicotine free for two weeks beforehand. My kids really want me to quit smoking. I have to have a clean UA for my parole officer. 

Handout• Strategies for Evoking Change Talk in Motivational Interviewing

QUIZ: Recognizing Change & Sustain Talk/Responding

Change or Sustain?

Change or Sustain Talk?Reflect/respond to this

statement

ACKNOWLEDGEMENTS/REFERENCES

Unless otherwise noted, the materials in this presentation are from/adapted from the following publications/individuals/organizations:

Miller, WR and Rollnick, S.  Motivational Interviewing.  Helping People Change.   New York:  The Guilford Press.  2013.  Third Edition.

The Motivational Interviewing Network of Trainers (MINT),  and especially Patricia Figueroa, M.Ed., Lorraine Reitzel,  Ph.D., Nanette Stephens, Ph.D., Theresa Moyers, Ph.D., and William Miller, Ph.D.  (training, mentoring, and sharing of materials). 

Stephen Malcolm Berg‐Smith.  Advanced MI Training.  Sept. 28‐30, 2011, San Francisco, CA. 

The Motivational Interviewing website: http://www.motivationalinterviewing.org/

Special thanks toPaul Cinciripini, Ph.D.,  Janice Blalock, Ph.D.,  Maher Karam‐Hage, MD, David Wetter, Ph.D.  and Diane Beneventi, Ph.D., for training opportunities, encouragement and support for training.